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FEATURES OF THE CLINICAL PICTURE OF CHRONIC PYELONEPHRITIS IN WOMAN Vafoeva NA. Email: Vafoeva696@scientifictext.ru
Vafoeva Nigora Abrorovna - Assistant, DEPARTMENT OF PROPEDEUTICS OF INTERNAL DISEASES,
SAMARKAND STATE MEDICAL INSTITUTE, SAMARKAND, REPUBLIC OF UZBEKISTAN
Abstract: pyelonephritis in woman is the most common kidney disease in all age groups. A higher incidence of pyelonephritis in girls and woman is due to the anatomical and physiological characteristics of the female body. The high prevalence of chronic pyelonephritis, its exacerbation, complications in woman childbearing age affect their overall incidence, life expectancy and reproductive function. Urinary sediment in woman with pyelonephritis is characterized by a polymorphic picture. An increase in the level of creatinin in the blood is noted.
Keywords: chronic pyelonephritis, pyelocaliceal system, kidney damage, creatinine.
ОСОБЕННОСТИ КЛИНИЧЕСКОЙ КАРТИНЫ ХРОНИЧЕСКОГО ПИЕЛОНЕФРИТА У ЖЕНЩИНЫ
Вафоева Н.А.
Вафоева Нигора Аброровна - ассистент, кафедра пропедевтики внутренних болезней, Самаркандский государственный медицинский институт, г. Самарканд, Республика Узбекистан
Аннотация: пиелонефрит у женщин - наиболее частое заболевание почек во всех возрастных группах. Более высокая заболеваемость пиелонефритом у девочек и женщин обусловлена анатомо-физиологическими особенностями женского тела. Высокая распространенность хронического пиелонефрита, его обострение, осложнения у женщин детородного возраста влияют на их общую заболеваемость, продолжительность жизни и репродуктивную функцию. Мочевой осадок у женщины с пиелонефритом имеет полиморфную картину. Отмечается повышение уровня креатинина в крови.
Ключевые слова: хронический пиелонефрит, чашечно-лоханочная система, поражение почек, креатинин.
UDC 616.62-002-085
The relevance of the problem. Chronic pyelonephritis (CP) is a chronic nonspecific infectious and inflammatory process with predominant and initial damage to the interstitial tissue, calyx-pelvic system and kidney tubules with subsequent involvement of the glomeruli and vessels of the kidneys [1, 2].
Kidney damage in CP is often bilateral. The incidence of chronic pyelonephritis is 15-20 cases per 100,000 populations per year, the prevalence among hospitalized patients is 73 cases per 100,000 patients. CP is more common in women. Pyelonephritis ranks second in frequency after acute respiratory diseases, first in the structure of kidney pathology and still tends to grow. In the USA, 2732 people died of pyelonephritis in 1980, 1126 died in Great Britain, 1786 people died in Germany [3, 4].
The widespread prevalence of urinary tract infections determines their high not only medical, but also social significance. For example, in the United States, urinary tract infections are more than 7 million cases a year the reason for seeking medical help. In the same country, pyelonephritis accounts for 100,000 hospitalizations annually [5].
Chronic pyelonephritis remains an urgent problem both in nephrology and in general pathology. This is due primarily to the fact that this disease is more common among women of working age. Pyelonephritis in women is the most common kidney disease in all age groups. The higher incidence of pyelonephritis in girls and women is due to the anatomical and physiological characteristics of the female body [6, 7].
The high prevalence of chronic pyelonephritis, its exacerbation, complications in women of childbearing age affect the indicators of their overall morbidity, life expectancy and reproductive function. All this determines the enormous social significance of the problem of chronic pyelonephritis in women.
The aim of this work was to study the features of development, clinical course and to assess the prognostic value of symptoms of chronic pyelonephritis in women.
Materials and research methods. All patients with CP divided by age. Patients under 20 years old accounted for 12% (4 patients), from 21 to 30 years old - 34% (12 patients), from 31 to 40 years old - 12% (4 patients), from 41 to 50 years old - 24.0% (8 patients), over 50 years - 18.0% (6 patients).
This means, as our studies show, chronic pyelonephritis is most often diagnosed in women aged 21 to 30 years, which, in our opinion, is associated with the presence of a large number of causes of this disease at this age.
The plan of the study of the patients included the clarification of complaints, the collection of data from the anamnesis of life, disease, examination of patients, blood and urine tests, functional and instrumental examination of the kidneys. When clarifying complaints, symptoms such as an increase (up to 40 ° C) in body temperature, chills, general malaise, and thirst were taken into account.
Results and discussion. The symptoms of pyelonephritis were unilateral or bilateral pain in the lumbar region, aggravated by palpation, a positive Pasternatsky symptom, tension on the side of the affected kidney - tension of the anterior abdominal wall, oliguria (due to significant fluid loss through the lungs and skin, as well as increased catabolism), frequent urge to urinate. Headache, nausea, vomiting were indicators of rapidly growing intoxication, arterial hypertension is a frequent symptom of chronic pyelonephritis, especially bilateral. The frequency of clinical forms of CP was studied, it was shown that the recurrent form is diagnosed in 56.0%, anemic - in 15.0%, hypertensive - in 15.0% and septic - in 9.0% of patients.
The recurrent and anemic form is recorded in all age groups, the hypertensive form is more often in patients aged 40-50 years, the septic form is over 50 years old. It was revealed that with CP in 47.0% of patients there is an increase in the level of cretinin in the blood (on average 166.0 ± 10.5 mmol/l). An increase in cretinin of a high and medium degree is observed with septic and hypertensive, and a moderate degree of increase is observed in a recurrent form of the disease.
Ultrasound in 58.8% of patients shows an increase in the size of the kidneys, in 32.3% -signs of "wrinkling of the kidneys" and deformation of the calyx-pelvic system. Wrinkling of the kidneys is most often detected in hypertensive and anemic forms of pathology. Urinary sediment in women with pyelonephritis is characterized by a polymorphic picture.
Leukocyturia, pyuria and bacteruria are most typical for septic and recurrent, single casts and altered erythrocytes, oxalate and phosphoric acid salts in urine - anemic and hypertensive form of the disease. Poor living conditions - lack of natural gas, unsatisfactory condition and location of the toilet and bath (76.0%), lack of knowledge of personal hygiene, toilet (71.0%) are factors contributing to the development and aggravation of CP. It is shown that chronic endometritis, undergone certain operations on the uterus and its appendages: blowing the fallopian tubes, removing ovarian cystomas and amputation of the uterus are factors of CP disease. Of the diseases of the urinary tract, pyelonephritis in women is more often promoted by chronic cystitis (70.6%). Obstetric and gynecological factors - termination of pregnancy by miscarriages, abortions, antenatal fetal death, play an important role in the development of CP in women.
Conclusions
1. By age, the recurrent and anemic form is recorded in all age groups and develops more often in the initial stages of the disease, the hypertensive form - more often in patients aged 41-50 years, the septic form - over 51 years; hypertensive and septic forms develop with a disease duration of more than 5 years.
2. Urinary sediment in women with pyelonephritis characterized by a polymorphic picture. Proteinuria is most characteristic of anemic, hypertensive and septic form of the disease. Leukocyturia, pyuria and bacteruria are most typical in septic and recurrent, single casts and altered erythrocytes, oxalate and phosphoric acid salts in urine - anemic and hypertensive form of the disease
3. With CP, 47.0% of patients have an increase in the level of cretinin in the blood (on average, 166.0 ± 10.5 mmol / l). An increase in cretinin of a high and medium degree observed with septic and hypertensive and a moderate degree of increase is observed in a recurrent form of the disease.
4. Poor living conditions, improper hygiene of the genitals and a burdened obstetric and gynecological history are factors contributing to the development and severity of CP.
References / Список литературы
1. Alyayev Yu.G., Grigoryan V.A., Sultanova Ye.A. i dr. Primeneniye flukanazola dlya lecheniya gribkovykh infektsiy v urologii. Russkiy meditsinskiy zhurnal, 2006. 14 (28): 2032-2035.
2. Dobronravov V.A., Smirnov A.V., Kayukov I.G. Mnogogrannaya al'buminuriya: aspekty klinicheskogo znacheniya. Nefrologiya, 2009. 13 (3): 33-37.
3. Zhevlakova Yu.A, Zakharova G.V., Khokhlova O.I., Ust'yantseva I.M. Mikrobiologicheskiy peyzazh i produktsiya b-laktamaz rasshirennogo spektra deystviya pri infektsii mochevyvodyashchikh putey. Klinicheskaya meditsina, 2009. № 3: 56-59.
4. Talha H. Imam, MD, University of Riverside School of Medicine .
5. Vafoyeva N.A., Gaffarov Kh.Kh. Osobennosti kliniko-laboratornoy diagnostiki khronicheskogo piyelonefrita u zhenshchin //Natsional'naya Assotsiatsiya Uchenykh, 2016. № 1. S. 20-21.
6. Yarmukhamedova S.Kh., Normatov M.B., Vafoyeva N.A. Osobennosti sutochnogo profilya arterial'nogo davleniya u bol'nykh khronicheskim glomerulonefritom // dostizheniye nauki i obrazovaniya, 2020. № 11. S. 58-61
7. Toirov D.R., Toirov E.S. Metabolicheskiy sindrom pri podagre: vzaimosvyaz' s funktsional'nymi narusheniyami pochek // Voprosy nauki i obrazovaniya, 2019. № 28 (77).
